Freeman J, Goldmann D A, Smith N E, Sidebottom D G, Epstein M F, Platt R
Channing Laboratory, Department of Medicine, Brigham and Women's Hospital, Boston, MA.
N Engl J Med. 1990 Aug 2;323(5):301-8. doi: 10.1056/NEJM199008023230504.
Coagulase-negative staphylococci are now the chief cause of bacteremia in neonatal intensive care units. To investigate potential risk factors for this nosocomial infection, we conducted a case--control study among 882 infants treated in two neonatal intensive care units during 1982.
The 38 case patients and 76 controls were similar with respect to 27 indicators of the severity of the underlying illness. In addition, of the 20 potential risk factors for bacteremia that we investigated, only 2 met conventional criteria for causality. Infants with coagulase-negative staphylococcal bacteremia were 5.8 times as likely as controls (95 percent confidence interval, 4.1 to 8.3) to have received intravenous lipid emulsion before the onset of bacteremia. Because the use of lipids was common, 56.6 percent of all of the cases of nosocomial bacteremia could be attributed to lipid administration. Infants with bacteremia were also 3.5 times as likely as controls (95 percent confidence interval, 1.4 to 8.3) to have had a percutaneously inserted central venous catheter (attributable risk, 14.9 percent). The induction time for bacteremia after lipid administration, usually through peripheral catheters, was often less than one day. In contrast, the average induction period for nosocomial bacteremia associated with the use of central catheters, which were rarely used for lipid administration, was at least 5.5 days. Similar analyses of data on an additional 31 neonates treated in 1988 confirmed the strong and apparently independent association of coagulase-negative staphylococcal bacteremia with the intravenous administration of lipids (adjusted odds ratio, 5.3; 95 percent confidence interval, 3.5 to 6.7).
The risk of coagulase-negative staphylococcal bacteremia in infants in neonatal intensive care units can be attributed primarily to the intravenous administration of lipid emulsions. Since lipids are critical for the nutritional support of premature infants, further studies are needed to examine the pathogenesis and prevention of lipid-associated bacteremia.
凝固酶阴性葡萄球菌目前是新生儿重症监护病房菌血症的主要病因。为了调查这种医院感染的潜在危险因素，我们于1982年在两个新生儿重症监护病房对882名婴儿进行了一项病例对照研究。
38例病例患者和76例对照在27项基础疾病严重程度指标方面相似。此外，在我们调查的20项菌血症潜在危险因素中，只有2项符合因果关系的传统标准。凝固酶阴性葡萄球菌菌血症婴儿在菌血症发作前接受静脉脂质乳剂的可能性是对照组的5.8倍（95%可信区间，4.1至8.3）。由于脂质的使用很常见，所有医院获得性菌血症病例中有56.6%可归因于脂质给药。菌血症婴儿拥有经皮插入中心静脉导管的可能性也是对照组的3.5倍（95%可信区间，1.4至8.3）（归因风险为14.9%）。脂质给药后菌血症的诱导时间（通常通过外周导管）通常少于1天。相比之下，与很少用于脂质给药的中心导管使用相关的医院获得性菌血症的平均诱导期至少为5.5天。对1988年治疗的另外31名新生儿的数据进行的类似分析证实了凝固酶阴性葡萄球菌菌血症与静脉脂质给药之间存在强烈且明显独立的关联（调整后的优势比为5.3；95%可信区间，3.5至6.7）。
新生儿重症监护病房婴儿发生凝固酶阴性葡萄球菌菌血症的风险主要可归因于静脉注射脂质乳剂。由于脂质对早产儿的营养支持至关重要，需要进一步研究来探讨脂质相关菌血症的发病机制和预防措施。
